Abstract
Building on the experience of the 2013–2014 wild poliovirus outbreak in the Horn of Africa, this study examines applied strategies that helped to engage pastoralists of the Somali cluster (Somalia, Somali Region of Ethiopia, and North-East Kenya) in supplementary immunization activities. Aimed at being applicable to other public health interventions, the study synthesizes knowledge about Somali pastoralism in the Horn of Africa and explains the approaches used for tracking nomadic groups and creating dialogue, as well as building trust to enable better vaccination opportunities for pastoralist children. Interventions across the three countries included creating a network of informants and influencers, engagement with clan leaders, mapping of water points and livestock markets, forming a partnership with an animal vaccination program, cross-border coordination, and establishment of permanent transit vaccination points. The proportion of children who had never been vaccinated against polio in the overall incidence of children reported with nonpolio acute flaccid paralysis in Somalia was used as an outcome measure before and after the interventions. Results demonstrate that the proportion of these zero-dose children was reduced from 44.6% to 19.5% between 2014 and 2015. Researchers discuss viability of pastoralist-focused approaches, as well as challenges associated with them, including the high-cost per child reached, lack of disaggregated epidemiological and social data for nomads, and a need to create special tools and strategies. This research provides practical recommendations to public health practitioners who are facing the challenge of reaching pastoralist populations with health services.
Acknowledgments
The authors honor the lives of Payenda Gul Abed and Brenda Kyeyune, the polio colleagues of UNICEF Somalia who lost their lives on April 20, 2015, in a terrorist attack on U.N. staff in Garowe, Somalia. Their contribution to stopping the WPV1 outbreak will always be remembered. The authors also recognize thousands of vaccinators, social mobilizers, and community leaders that are working selflessly every day in the most difficult context of the Horn of Africa, protecting children from the paralyzing disease.
Funding
This research project was supported by Communication Initiative—a project of the U.S. Agency for International Development.
Notes
1. This terms is not to be confused with the administration of oral polio vaccine at birth commonly referred to as the zero dose.